E arlier this year, former Hastings resident Ryan Ernst became the first psychologist in Iowa to be licensed to practice psychiatric medicine.
Ernst is a 1993 graduate of Hastings High and 1997 graduate of the University of Nebraska-Lincoln.
He became a psychologist in 2002 after receiving a doctorate in psychology from Nova Southeastern University in Fort Lauderdale, Florida.
He became the first psychologist in Iowa to be licensed to practice psychiatric medicine in April after completing the additional training needed for a master’s degree in psychopharmacology.
He and his wife, Joni, have three children: Gylz, 19; Grey, 15; and Milan, 10.
Prior to pursuing his psychopharmacology degree, Ernst had been working for Madonna Rehabilitation Hospital in Lincoln for about nine years as a neuropsychologist.
Ernst continues to live in Lincoln, but now works for the Clarinda Regional Health Center in Clarinda, Iowa.
“It was something I was interested in even before graduate school,” he said of becoming a prescribing psychologist. “I worked at a clinic for a psychologist here in Lincoln. It was a passion of his, and I got introduced to it — the idea of psychologists prescribing — through that psychologist who was kind of my mentor at the time. It was always something I was interested in, but it was always kind of out of my reach because there were no states around Nebraska that allowed psychologists to prescribe until Iowa passed their bill in 2016. That opened the door for this being more of a realistic possibility for myself.”
Historically, only medical doctors such as psychiatrists and other physicians were able to prescribe medications for mental health conditions.
The U.S. Department of Defense launched a program in 1989 to train psychologists in medicine.
That eventually led to New Mexico being the first state to pass a bill into law allowing appropriately trained psychologists the ability to prescribe medications for mental health conditions.
Iowa passed a similar law in 2016 that went into effect in 2019 with associated legislative rules and regulations.
Iowa became the fourth of five states that currently allow prescribing psychologists. Besides New Mexico and Iowa other states are Louisiana, Illinois and Idaho.
Ernst started a separate master’s degree in clinical psychopharmacology in 2017. It was the next available class after the bill in Iowa passed.
The 2 ½-year program concluded with clinical hours, which is a component that is required prior to being licensed.
He found the Clarinda Regional Health Center in Clarinda.
It is a Critical Access Hospital in a town of about 5,000 people.
The hospital had been using psychiatric telehealth services through a psychiatrist in Omaha.
Ernst needed supervised hours. It was an agreement with a mutual benefit.
He started at Clarinda Regional Health Center in December 2019, working as a psychologist while also doing his residency.
Chuck Nordyke, CEO of Clarinda Regional Health Center, estimated prior to Ernst’s arrival, the hospital provided about 150 mental health visits a year through telehealth services.
Nordyke, who has been at Clarinda Regional Health Center for three years, said the need for expanded mental health services was quickly apparent.
“When I got here that was the biggest thing I heard from the community was ‘We need mental health services, we need mental health services,’ ” he said.
A local principal, who had met Ernst and knew he was looking for a hospital in which to do his residency, put Nordyke in touch with Ernst.
Nordyke thought Ernst was a great fit.
“At this point, it’s only been a little over a year of us being open, we have the largest mental health practice in southwest Iowa,” Nordyke said. “We’ve grown from having nothing to being the biggest player in this corner of the state for sure.”
Clarinda Regional Health Center now averages more than 500 mental health visits per month.
“To say that this has exceeded our expectations, especially within the first year, is an understatement,” Nordyke said. “It is a huge, huge practice for us.”
He was intrigued by Ernst’s background in psychology.
“Ryan is a trained neuropsychologist,” he said. “So he has advanced training on the psychology side. After talking with Ryan, I liked his approach. I liked his background working with Madonna and that rehab component.”
Around the same time Ernst started there, the hospital was hiring its first mental health nurse practitioner in Benn Rayment.
“Those two took the lead in developing the practice and hiring the next folks and growing it to where it is now,” Nordyke said.
Psychologists have different training than psychiatrists when it comes to mental health, he said.
“So to be able to bridge those two, the medicine with the training the psychologists have, I think was going to be a huge win for us,” he said. “Ryan fits Benn, and Benn fits Ryan; they work together tremendously.”
Ernst will see children as young as 5 all the way up to patients in their 90s.
“There are some real limitations of using telehealth only, and that’s really for any aspect of health care,” he said. “It’s great for some circumstances, but as the main delivery method of mental health services there are some real shortfalls to that. It’s very important in providing mental health services — especially counseling or psychotherapy — to people there has to be this established trust. I think that is difficult to establish sometimes when you have never really been in the same room as somebody before and have only seen them on a TV screen.”
Nordyke said Clarinda Regional Health Center is working to promote the fact it is the first hospital in Iowa with a practicing psychologist.
Ernst and Nordyke have talked about establishing a residency program for other psychologists who would like to go through the training with him.
Clarinda is 94 miles from Lincoln. Ernst makes that drive twice a day, four days a week, spending Wednesdays at home working as a neuropsychologist. He writes reports and assesses patient brain functions.
As the first prescribing psychologist in a neighboring state but still living in Nebraska, Ernst advocates for allowing prescribing psychologists. He has testified in committee hearings for several bills at the Nebraska Legislature.
He said it’s an ongoing effort for the Nebraska Psychological Association to see this bill passed.
“The reason why there was initial interest in psychologists being able to prescribe psychiatric medications is simply because of the lack of access to care that people have,” he said. “It tends to be worse in the rural areas and of course most of Nebraska is rural, so you could imagine that’s an issue for a great number of Nebraskans.”